基于导航的立体定向脑电图在癫痫外科中的应用

发布时间：2018-08-27 06:35

【摘要】：目的通过综合应用神经导航结合脑立体定向技术获取患者三维立体脑电图以精确定位颅内致痫灶指导外科手术治疗,观察在难治性癫痫患者治疗中的安全性、有效性。方法我科收治的14例药物难治性癫痫患者行颅脑三维磁共振及头颅静脉成像,利用Brain-LAB神经导航系统融合影像数据,建立立体大脑及皮层静脉模型,设计路径避开皮层血管,导航生成靶点坐标,然后在Leksell立体定向下植入立体定向电极,分析其安全性及有效性。结果 14例患者共植入94枚电极,所有电极均成功植入,主要并发症是一例电极植入位置偏移及该电极导致的颅内少量出血及一例间接颅内感染,术后进行视频脑电监测,确定颅内致痫灶并进行手术(一例患者脑深部电刺激治疗),术后随访疗效满意。结论建立立体大脑及皮层静脉模型有效避免电极植入出血;立体定向电极植入作为侵袭性评估致痫灶的方法是安全、有效的,并在行硬膜下皮层电极植入术后效果不佳的病例中体现优越性。
[Abstract]:Objective to evaluate the safety and efficacy of neuronavigation combined with stereotactic technique in the treatment of intracerebral epilepsy. Methods Fourteen patients with drug-resistant epilepsy were treated with three-dimensional craniocerebral magnetic resonance imaging and cephalic vein imaging. The three-dimensional cerebral and cortical vein models were established by Brain-LAB neuronavigation system to avoid cortical vessels. The target coordinates were generated by navigation and the stereotactic electrode was implanted under Leksell stereotactic orientation to analyze its safety and effectiveness. Results 94 electrodes were implanted in 14 patients, all the electrodes were implanted successfully. The main complications were the displacement of the electrode implantation, the small amount of intracranial hemorrhage caused by the electrode and the indirect intracranial infection. The video EEG monitoring was performed after operation. Intracranial epileptogenic foci were determined and operated on (one patient with deep brain stimulation). Conclusion Stereotactic electrode implantation is a safe and effective method to evaluate the invasiveness of epileptic foci. And the superiority of subdural cortical electrode implantation was demonstrated in the cases with poor effect.
【作者单位】：上海交通大学医学院附属仁济医院功能神经科;
【分类号】：R651.1

【共引文献】